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September 10, 2008

New Medical Home Concept More Efficient

by Sam Savage

A new system of designating patients to a medical "home" reduced hospital admissions by 20 percent and costs by 7 percent, researchers at the privately-held Geisinger Health System in Pennsylvania reported on Wednesday.

The new approach could offer new ways to handle health care in the U.S., researchers wrote in the journal Health Affairs.

"This is the direction in which we need to move our fragmented, broken health care system," said Commonwealth Fund President Karen Davis, a board member of Geisinger Health System who helped write the report.

Geisinger's Chief Technology and Innovation Officer Dr. Ronald Paulus said the new approach could present patients with an effective way of reversing the trend of paying more per capita for health care.

"It provides a centralized place for a consumer, patient, to receive their care," Paulus said.

The primary care medical staff are available around the clock to refer patients to specialists, provide direct care, help with billing and other queries.

"They remain advocates for the patient and his or her family," Paulus said.

This approach contrasts to the decades-old concept of a "gatekeeper" who would approve all specialist care.

"Their financial incentive was not necessarily to provide the most care. They made the most money if they could get by with a lower amount of care," Paulus said.

Studies show that although Americans pay more per capita for health care, they are still more likely to die prematurely from preventable diseases than people in other well established countries.

The proposed medical "home" concept pays a practice up front to take care of patients and gives them a large bonus if they meet targets, such as controlling blood sugar, cholesterol, preventing heart attacks and screening for cancer.

"They can't scrimp to get efficiency," Paulus said. "We paid in advance for the actual work but we earned the savings on the back side."

"The doctors made more money -- they were happy. The health plans saved money -- they were happy. Patients got more care -- they were happy. But someone has to provide the funding to kick-start the program."